Pharmacists are working in many locations, not just behind the counter at the drugstore. Clinical pharmacists are in hospitals, assisted-living facilities and more, and they can play an important role in helping you and your loved ones manage your medications, reduce side effects and be healthier. MedShadow spoke to Chad Worz, Pharm.D, CEO of the American Society of Consultant Pharmacists (ASCP), which partners with TaperMD. TaperMD is a tool that evaluates medical risk and the role of different types of pharmacists and how they may help reduce side effects and ensure that your medicines are both safe and effective.
MedShadow: What are some of the other types of pharmacists that a person might come in contact with?
Worz: Pharmacists are [present] throughout the healthcare system. There are pharmacists in hospitals. Many people probably don’t realize that there are pharmacists who work in long-term-care settings, such as assisted-living facilities and nursing homes. They also work in group homes that take care of people who have intellectual and developmental disorders. The pharmacists in nursing homes not only provide the medications and package them in a way that’s efficient for people living there, but they also go back monthly and review the medication lists of the patients living there and communicate with their doctors and nurse practitioners about ways to make that medication therapy more efficient.
Over the years, because of the growth in the older population and their propensity to need medications, they have been faced with a lot of polypharmacy issues. The pharmacists in these settings typically worry about prescribing a medication that is designed to treat a side effect of another medication that person might be on. So many pharmacists might consider themselves in the business of getting rid of medications.That’s pretty common when you look at individuals in assisted-living and nursing homes.
MedShadow: How has the role of a pharmacist changed in recent years?
Worz: The pharmacist has really risen to be more of a medication manager. If you go back in history, [pharmacists] have been a trusted community health professional. What’s changed over time is obviously that pharmacies have gotten busier. It’s been harder to create those relationships with a pharmacist, but that doesn’t make that [the role] any less important for people. What you’re seeing today is a slow revolution of the role the pharmacist plays in health care. Recently, for example, pharmacists became authorized to order [the antiviral medication] Paxlovid for patients who have tested positive for COVID-19. That represents a pretty big step. We recognize that getting people treated quickly is a priority. Pharmacists have at their disposal the medical records and information they need to safely get people started on a therapy that, in all likelihood, could certainly keep them away from severe disease and, potentially, even save their life.
MedShadow: Can a patient or a family member might make their own appointment with a pharmacist outside of the context of long-term care?
Worz: Certainly. That’s available through the the American Society consultant pharmacists, ASCP, where I work. We have a directory called HelpWithMyMeds.org, which. That is something people can access to look up a local pharmacist in their area who does this kind of work. Unfortunately, right now, Medicare doesn’t pay for these kinds of services, so a lot of it is either delivered pro bono or at a cost to the patient. But again, those things are changing. We’re starting to see more opportunities for pharmacists to either work with physicians to gain reimbursement for those services, so that the patient’s not responsible or seeing new payment models, where the insurance companies are covering those services.
MedShadow: How should a patient or caregiver prepare for a meeting with a pharmacist?
Worz: It’s important for everyone to keep a list of what they currently take, both prescribed and over-the-counter (OTC). We know that in the community setting, people have multiple specialists that they go to. Many people might search for where they can get medications in the least expensive manner,so they might get a few medications from one pharmacy and a few from another. They may use some OTC products, because they may have the illusion that [OTC drugs are] safer and not something they have to discuss with their doctor or pharmacist. In reality, we need that comprehensive list to really look at what’s going on with the medication therapy and find ways again to make it more efficient and, potentially, lower the medication burden for the patient.
MedShadow: How did you get involved with TaperMD?
Worz: TaperMD came to ASCP as a partner. Safety is one thing we spend a lot of time on. As you age, your body changes and, as a result, the medications affect you differently, which can create a lots of risk. If you think of just a common example of somebody who’s been taking a medication for 25 years. Their body is a lot different 25 years later. If they’re not aware of some of those changes, or what those medications could do because of those changes, they might put themselves at risk.
We’ve also focused on the black box warnings that the Food and Drug Administration (FDA) puts on medications. A couple of the evidenced-based lists are the Beers list and the STOPP/START criteria. There’s also the Drug Burden Index (DBI)., and the anticholinergic burden score. All those things give us insight into what the potential risk is for an older adult on medication. What TaperMD has done is to consolidate that information into a database where, whether you’re a member of the public or you’re a health practitioner, you can go to that website, type in medication and get a whole list of what the risk is. You might ask, does it have a black box warning? Is it on the Beers list? That resource helps pharmacists as well as the public get a better sense of what medications they need to avoid or adjust, and what a safer alternative might be.
This interview has been edited for length and clarity.